How Often Should I Use Psychedelics?Nov 08, 2022
How often should I use psychedelics?
It's both a good and commonly asked question so I decided to put together this video blog and accompanying text to help persons understand more of what my thought process is when approaching this question and share some insights depending on the method or indication for psychedelic use.
The short answer would be 'as often as is good for you'.
Of course that's a little circular since the question is how often is good for me, but really highlights that there's no wrote schedule to being your personal best. I find that persons are oftentimes thinking or under the impression that there's a "right answer" and that if they search the internet long enough that they'll find it. I believe that the frequency (and dosing) for psychedelic use is really an individual choice or decision. It can depend on several factors, although three big ones are intention, indication, and response.
When persons are considering psychedelic use, they may also have a goal of finding the minimum dose and frequency that achieves goals. They will have to start somewhere and by considering substance, dose, set and setting, and responses they can make subsequent plans and adjustments depending on tolerability and benefits in a way that works toward a regimen that serves them well. This said, there's some information and cautions out there that can help guide decision making that I'll explore more now.
Frequency of Psychedelic Use by Modality
This modality of using psychedelics involves taking subperceptual doses fairly regularly. There are a few different regimens for microdosing ranging from less to more intensive. Click here for a more detailed discussion of microdosing. Due to the activity of psychedelics like psilocybin or LSD at serotonin 2B (5HT2B) receptors there is concern for risks of Valvular Heart Disease (VHD) with long-term chronic use. Until further safety data is available it may be wise to avoid intensive microdosing regimens for long periods of time. It is reasonable to consider a course of microdosing for 1-2 months then take time off that's at least half as long as the microdosing course. Persons may also consider beginning with lower doses and less frequent administration schedules that avoid stacking with other ingredients. They may need to explore intensifying dosing and frequency based on responses, although they begin to build a relationship to and understanding of the substances' effects with less chance of being overwhelmed or not being able to discern effects of different ingredients with this approach.
This modality of using psychedelics involves taking moderate to large doses of psychedelics in a protocolized setting. It's accompanied by preparation therapy before, emotional support during experiences, and integration therapy post use. These experiences can rank amongst the most intense and personally meaningful events of an individual's life or result in significant stirring of deep emotions. In clinical trials treatments have ranged from 1-3 sessions spaced a week to a month apart. MDMA-assisted therapy trials space the sessions a full month apart due to the neurotransmitter depleting effects of MDMA and necessary refractory period to allow recovery before the next use. With psilocybin-assisted therapy trials have varied their administration regimens from as little to 5-7 days apart to around a month apart. Due to the rapid tolerance that occurs to macrodoses of LSD or psilocybin, there can be rapidly diminished effects when persons use larger doses for several days in a row and a period of 5-10 days may be necessary to continue achieving their full potency. It's important for persons to take periods of time between experiences that 'bring up a lot' or are otherwise 'big' experiences for integration.
This modality of using psychedelics involves taking small to large doses of psychedelics in ritualized settings. There are varying amounts of support offered ranging from minimal to extensive including both emotional and medical support. Whereas psychedelic therapy has been conducted closer to a discrete intervention than an ongoing course of treatment, sacramental use often involves ongoing and intermittent use of psychedelics as part of a religious or spiritual path. One study followed long-term and regular users of ayahuasca and matched them with demographically similar controls. Ayahuasca users drank ayahuasca at least 50 times over 2 years (biweekly use). Ayahuasca use was associated with thinning of the Posterior Cingulate Cortex (PCC), which is a portion of the Default Mode Network (DMN). It was also associated with increased personality traits of 'self-transcendence'. While changes were noted, they did not appear pathological in nature.
Anti-inflammatory, Pain, Headaches
There is less data available to guide administration schedules when persons are approaching psychedelics for management of cluster or migraine headaches. The Handbook of Medical Hallucinogens notes that a popular regimen with cluster headaches is to take 3 doses of of psilocybin or LSD spaced 5 days apart. One retreat center discusses a 'Burst and Pulse' dosing modality in which persons burst with moderate doses of psychedelics (e.g., 2g dried mushrooms) and follow this up with smaller doses (1-1.5g dried mushrooms) every 5 days for 4 more administrations. The rationale is that use of the burst dose can help break the headache or pain cycle and that use of smaller doses continue to reduce inflammation or otherwise work to reduce headache intensity or frequency. The spacing of doses 3-7 days apart correlates closely with the typical window for detecting markers of neuroplasticity that occurs with psychedelic use. After completion of the 'burst and pulse' induction an individual can determine response and period of time it keeps them well. Further cycles for flares or prophylactic wellness regimens can then be designed.
Hallucinogen Use Disorder
Substance Use Disorders (SUDs) involving classical psychedelics like psilocybin or LSD are not common, while other psychedelics like ketamine or MDMA have a relatively higher addiction potential. Psychedelics are mostly demonstrating anti-addictive effects. Yet, many persons that begin using psychedelics may wonder at a certain point if they are using too much or are 'addicted' to psychedelics. Persons can reflect upon the questions below to decide if their use pattern is worrisome or may signal they are overusing or have problems using psychedelics. When 'yes' is an answer to several of the above questions then a SUD could be present. If 'no' is the answer to all or almost all of the questions then there is likely no need to worry about psychedelic use being a SUD.
- Are you taking larger amounts or using longer than you intended?
- Do you want to cut down or stop but not managing to?
- Do you spend a lot of time obtaining, using, and recovering from use?
- Do you have cravings or urges to use the substance?
- Is substance use causing problems in relationships?
- Do you forego important social, occupational, or recreational activities to use the substance?
- Are you using substances in high-risk scenarios?
- Do you continue to use even though you know you have a physical or psychological problems that could have been caused by the substance?
High Notes on Psychedelic Use
There are some reasonable guideposts to consider available when determining a frequency for psychedelic use, although the decision is personal and depends on many factors. Reflection upon reasons for use, goals of use, responses from use, and whether use could be a problem can help persons decide if their use is appropriate or needs adjusted. I look forward to having more data available to guide decisions on frequency of use. However, I ultimately believe that psychedelics are about finding and discovering ones own truth, which may be reflected in dosing, substance, or regimen choices.
If you'd like to walk through your details in a consultation to discuss psychedelic use you can book a time and learn more by visiting the consultation page.
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